Risk Reduction Counseling (RRC) is a major component of the WISEWOMAN Program. A participant-centered risk reduction plan should be developed collaboratively by the participant and provider by utilizing Team-Based Care and Bi-Directional Referrals. WISEWOMAN providers should offer options, not directives, and participant goals should be acceptable to the participant, explicit and achievable.

RRC must be initiated in person at the initial SMHW/WISEWOMAN integrated office visit. If lab results are not available at the time of the visit, providers can provide RRC based on other available participant health information and then complete RRC with the participant when lab results are obtained. After RRC requirements are complete, the provider will be reimbursed for services and participants can then be referred to additional WISEWOMAN services.

Risk Reduction Counseling Tools

There are a number of approaches and curricula designed to provide the necessary skills for effective client-centered counseling. It is highly recommended that all provider staff conducting RRC be trained in at least introductory level Motivational Interviewing.

Common Elements of Motivational Interviewing

• Talking with, rather than to, the client
• Responding with sensitivity and considering health literacy or cultural issues that may emerge
• Maintaining a non-judgmental attitude, using active listening, asking open ended questions
• Supporting positive risk reduction changes already made by the client
• Assisting the client in identifying barriers to risk reduction (e.g., knowledge gaps, skills needed, socio-economic and other life circumstances that are barriers to being healthy)

WISEWOMAN Risk Reduction Counseling (Initial Screening) Requirements

• Evaluate and review the patient-reported information on the WISEWOMAN Assessment Form (tan) regarding a woman’s risk for CVD including:
  • Previous CVD and risk levels
  • Use of medications for HTN, cholesterol and/or diabetes
  • Nutritional habits
  • Physical activity
  • Alcohol use
  • Overall wellness/mental health
  • Smoking status/tobacco use
  • Readiness to change health habits
• Obtain clinical screening measures using the WISEWOMAN Screening Form (light pink) including:
  • Height, weight and BMI
  • Waist and hip circumference for waist-to-hip ratio (optional)
  • Two complete blood pressure (BP) readings with an average reading
  • Laboratory tests (complete lipid panel and A1C or fasting glucose) completed 30 days before or 30 days after the screening office visit

*Note: Fasting labs are preferred over non-fasting values (see Laboratory Values for detailed guidelines)*

• Review the results of the screening with the WISEWOMAN participant and provide participant-centered Risk Reduction Counseling on cardiovascular risk
• Refer WISEWOMAN participants for follow-up office visits, if applicable, for abnormal screening results and/or ALERT values including; elevated blood pressure, cholesterol, blood glucose, smoking cessation medication and mental health referrals
• Refer all WISEWOMAN participants who are willing and ready for change to Lifestyle Education Programs (LSPs) including: Health Coaching, Missouri Quitline, Eating Smart-Being Active (ESBA), Take Off Pounds Sensibly (TOPS), Diabetes Prevention Program (DPP), Weight Watchers (WW) and Self-Monitoring Blood Pressure (SMBP)
• Submit a WISEWOMAN Risk Reduction Counseling or WISEWOMAN Initial claim in MOHSAIC for the participant’s initial WISEWOMAN Screening visit for reimbursement of services with all required components